Mi­graines are of­ten mis­di­ag­nosed

I’m a woman in my 30s who has suf­fered from si­nus headaches for years. Al­lergy med­i­ca­tions haven’t helped. What else can I try?

Sea­sonal al­ler­gies can cause si­nus con­ges­tion, sneez­ing and a runny nose. But when you ex­pe­ri­ence pain and pres­sure in your head, it may be time to con­sider other causes. That’s be­cause si­nus prob­lems do not usu­ally cause headaches. At least, they don’t cause what most peo­ple re­fer to when they use the term “headache.” Most peo­ple with si­nus con­ges­tion re­fer to “head con­ges­tion,” not headache.

I spoke to my Har­vard Med­i­cal School col­league Dr. Wil­liam Kor­mos. He said that if you’re reg­u­larly ex­pe­ri­enc­ing headaches with nasal con­ges­tion, you may have mi­graine headaches. That’s be­cause mi­graines can cause si­nus pres­sure and clear dis­charge, just as they can cause the eyes to get red and teary.

Peo­ple with mi­graine headaches are of­ten mis­di­ag­nosed with si­nus prob­lems. That may be be­cause many peo­ple don’t as­so­ciate si­nus pain and pres­sure with mi­graine headaches. In fact, more than 80 per­cent of mi­graine suf­fer­ers report si­nus pain and pres­sure. Half also ex­pe­ri­ence nasal con­ges­tion or a runny nose. To add to the con­fu­sion, weather changes are com­mon mi­graine trig­gers. So your mi­graines might fol­low a pat­tern you as­so­ciate with — and mis­take for — sea­sonal al­ler­gies.

A doc­tor should be able to di­ag­nose the type of headaches you are ex­pe­ri­enc­ing. He or she will make the di­ag­no­sis based on an ac­cu­rate, de­tailed de­scrip­tion of your symp­toms. For ex­am­ple, nau­sea, vom­it­ing or sen­si­tiv­ity to light or sound are clues that your pain is re­lated to mi­graines.

Mi­graine headaches should be treated as soon as symp­toms be­gin, as any de­lay can make the headache harder to treat. The main­stay of mi­graine treat­ment is a group of drugs called trip­tans.

Another cru­cial part of mi­graine man­age­ment is preven­tion. Cer­tain ac­tiv­i­ties, foods and other fac­tors can trig­ger mi­graines. Iden­ti­fy­ing and avoid­ing your headache trig­gers may help re­duce how of­ten you have mi­graines and how badly they hurt. Com­mon trig­gers in­clude:

• Hor­mone lev­els (which may be af­fected by men­strual cy­cles or hor­mone-con­tain­ing med­i­ca­tion) • Lack of sleep • Travel • Changes in weather or al­ti­tude • Overuse of pain med­i­ca­tions Also ask your doc­tor about pre­ven­tive med­i­ca­tions. These are pre­scrip­tion drugs taken ev­ery day to re­duce the num­ber and the sever­ity of mi­graines. The drugs, also all used to treat other con­di­tions, in­clude beta block­ers, cal­cium chan­nel block­ers, ACE in­hibitors, an­ti­seizure drugs and some drugs used for de­pres­sion.